Psoriasis severity, comorbidity burden, and biologic therapy: a multicenter observational study using the Charlson Comorbidity Index

Background: Psoriasis is a chronic inflammatory disease associated with systemic comorbidities. The Charlson Comorbidity Index (CCI) quantifies comorbidity burden and estimates survival, but its relationship with psoriasis severity and biologic therapies remains underexplored. Objective: To evaluate the association between psoriasis severity and comorbidities, assess the impact of biologic disease-modifying antirheumatic drugs (bDMARDs), in particular (adalimumab [ADA], risankizumab [RISA], secukinumab [SECU]) on CCI and estimate 10-year survival in psoriatic patients versus controls. Methods: In this multicenter cross-sectional study, 343 psoriasis patients and 343 matched controls from 13 Italian centers were analyzed. CCI scores and comorbidity profiles were stratified by disease severity PASI score [Psoriasis Area and Severity Index] and treatment groups. Survival probabilities were estimated using a predictive model. Results: Psoriasis patients had significantly higher age-adjusted CCI compared to controls (p = 0.021), particularly in severe cases (PASI >10; p = 0.003). Peripheral vascular disease, cerebrovascular disease, and myocardial infarction correlated with disease severity. ADA-treated patients showed lower CCI than those on RISA or SECU (p < 0.05). The estimated 10-year survival did not differ significantly between psoriasis and controls. Conclusions: Psoriasis severity is associated with increased comorbidity burden, highlighting the importance of cardiovascular and metabolic screening. Biologic therapies may differentially affect comorbidity progression, supporting personalized treatment approaches.